12080191 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 19972 PORTAL PLZ COYIRACI'OR:KRT INC PERMITNO: 12080191
OWNER'S NAME: CIIUI DAVID K TRUSTER&ET AL 21001 SAN RANION VALLF-Y BLVD DATE ISSUED:08272012
OWNER'S PlIONE: 4087251763 SAN RAMON,CA 94583 PRONE NO:(915)5560632
❑ LICENSED CONfRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I_ PLUMB r
License Class-- V. Lic.N ? SLI (?n g r r_ r
M ECH RESIDENTIAL COMAIERCL�L
Contractor le L Z K)( _ Dmc g LX L � -
1 hereby affirm that I am licensed under the pro%isions of Chapter 9 JOB DESCRIPTION: REMOVE&REPLACE CLERESTORY WINDOW TO
(commencing with Section 7000)of Division 3 of the Business& Professions FACILITATE
Code and that my license is in full force and effect. REROOFING
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this pemtit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1500
permit is issued.
APPLICANTCERTI FICATION I APN Number:36945006.00 Occuponcy Type:
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state lases relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments•
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. o /2
62�-
Q o21 Issued by: ✓�ff/✓ /f�TG� Date: e�)—6P17-16?_Signature
❑ OWNER-RUILDER DECLARATION
RF--ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following tyro reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code). ALL ROOF COVERINGS TO Ill's CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's DAZARDOIIS NIATFRIAIS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California Health&Safety Code,Sections 25505,25533,and 25.534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Section 3700 of the Labor Code,for the perfommncc of the work for which this Safety Code.Section 25532(a).should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the flay Area Air Quality Management District 1 will
1 certify that in the performance of die work forwhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation Imus of California. If,aller making this certificate of exemption,I 7/�.,,,,-�w` p
become subject to the Worker's Compensation provisions of the Labor Code,I must Own�yt��1 d agentI7Ze. O eZ1 1
forthwith comply with such provisions or this permit shall be decried revoked t
AI'1'LICAN'1'CER'1'IpICA'1'ION
CONS'1'RIICI'ION LENDING AGENCY
I cenit•that I have read this application and state that the above infommtion is I hereby aRirn that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city mid county ordinances mond state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI I ITEC`f'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATION X0 I a '
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 I /�
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(cDcupertino.ora
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFER
R
ED ORICHN�AL PERMIT9
PROJECT ADDRESS P`G20. APN 4
OWNER NAME `` PHONE , 3 E, IMATL
(N ,VY QFV� O:fCI' C��V
STREET ADDRESS «n,.2 _\ \ CRY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
Sa:fn2 0.S <„bO,rQ, .
,STTREET ADDRESS CRY,STATE, ZIP FAX
LN OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CON. C ORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME V R 1T N ( LICENSENUMBER �r LICENSETIPE Q BUS.LIC0
E-MAIL
COMPANYNAME K �•l-rU /l/ e.`� E- AIL J l �j J �t SS OIpj
STREET ADDRESS '\ 1\ l.— �YY CRY,STATE,Z[P ONE
.1tool S Al eq Mo V.(Lck�(3��n1411 s N 2.aM.on CA cs83 s 5S6-o6
ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS,LIC P
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORX
2a c_ cJ S
EXISTTN'O USE PROPOSED USE CONSTR.TYPE PSTORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EX6TG NEW'FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODELAREA
PORCH ARRA DECK AREA TOTAL DECKA'ORCH AREA GARAGEAR[A: DETACH
ATTACH
P DWELLING UNITS: IS A SECOND UNIT YES SECONDSTORY YES
BEING ADDED'. ONO ADDITION'. ON
PRE-APPLICATION OYES IFY'ES,PROVIDECOPYOF ISTHERLDGAS ❑YES )REC 'ED Yf �..f-.� ` TOTAL VALUATION:
PLANNTNGAPPL. ONO PLANNING APPROVAL LETTER EICHLER HOME' 0 N N{� pgvJ
By my signature below,I certify to each of the following: I am the property owner or authorizdd a t to act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 have read the Description of Worl:and erify it is accurate. Iagree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize re rese s Denino to enter the almovF-identifiep property
for inspection purpose.
SignatureofApplimnUAgent: •Date: 11 Q 11 ':2
SUPPLEMENTAL INFORMATION REQUIRED PL`s cxccinee�`;-a'"- z � ov'ri c's1IF -New SFD or Multifamily y dwellings: Apply for demolition iL for *° ' = A+' r s�'t`
emormt VER THE-COUNTER q.'�' , ❑ BUp.DfNG PLAN REV TEW
existing building(s). Demolition permit is required prior to issuance
permit for new building. r❑ EXPRESS.,` ar,• t .R ❑-PLANNING PLAN REVIEW;- + '
f� ..,j
_Commercial Bldgs: Provide a completed hazardous Materials Disclosure srnn 'RTtD° R � ,g ❑ u Lemic W onl:s�+a "fb < .±'
;r e-.z •�.r¢ T'T<1 'Crt.rt-- �r.d�.f�`4t '"SR. 1P
form if anv Hazardous Materials are being used as pan of this project. A❑ uRi a .. — ' �. `y `
l4`" 4 ❑ P1RED �3Y'b f `%i -P`?Jn,
Copy of Planning Approval Letter or Meeting with Planning prior to .4
❑ MAJOR ;, A" ,T� ❑ <�•
submittal of Building Permit application. r �.�.,,�ar+fi_';y SANITARY SEWER DISTRICT -
t} ❑ f:\\NO,', E ALIIEALTII .)n3
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Em0ccncy Accesi Only
;.Portal P.'Iaza . Site - P.Ian
PVC-Roof WIECKS ASSOCIATES, INC.
Portal PlazaCondominiums ROOFING CONSULTANTS
1049A Alameda de.las Pulgas
Associa�
M & C.Association Management Services, Inc.
August 9, 2012
RE: Re-roof of Portal Plaza Units, Cupertino, CA 95014
To whom it may concern:
The Board of Directors for Portal Plaza Homeowners Association k)cated in Cupertino,
CA, has contracted with K.R.T. Inc. to remove and replace windows during 2012. They
have permission to acquire the necessary permits needed for the;HOA project.
If you have any questions, please feel free to contact me.
Thank you,
�'d (0
Grant Shetron, CMCA, AMS
Community Association Manager
As Agent for
Portal Plaza Homeowners Association
Rshetronna mccommunities.com
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